Inspection on 14/07/06 for The Limes Rest Homes

This inspection was carried out on 14th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Limes Rest Homes 25/09/08

The Limes Rest Homes 28/12/05

The Limes Rest Homes 22/08/05

The Limes Rest Homes 20/01/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Limes Rest Homes 75-79 Cartland Road Stirchley Birmingham West Midlands B30 2SD Lead Inspector Karen Thompson Unannounced Inspection 14th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Rest Homes Address 75-79 Cartland Road Stirchley Birmingham West Midlands B30 2SD 0121 443 1789 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) First Care Services Ltd Mrs Eileen Isobell Carlton Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the registration category is 28 older people with dementia (OP) The home can provide care for one person under 65 years of age for reasons of dementia. 28th December 2005 Date of last inspection Brief Description of the Service: The Limes is a care home providing personal care and accommodation for 28 people who are elderly and physically dependent due to old age. It is a private home owned by First Care Services Ltd. The home is situated in Cartland Road, Stirchley, Birmingham and is close to local amenities. The Limes is situated on a busy bus route but it is set behind a small front garden. It consists of three two-storey adjoining houses that have gradually been incorporated over the years. There are several lounges including one for smoking, a separate dining room and an attractive rear garden with patio, lawn and flower beds which provides an additional facility for residents to enjoy during the summer months. There is a large car park to the rear of the building. There are twenty single and four twin-bedded rooms. Some bedrooms have en-suite facilities and there are assisted bathing facilities in the home. There is a passenger lift and a stair lift. On the ground floor there is the kitchen where meals are prepared and a laundry. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The findings of this report are following a statutory unannounced inspection. One inspector carried out the inspection over an eleven-hour period. Information for the report was gathered from a number of sources: a tour of the building, examination of records and documents, talking to residents, relatives and staff members and direct and indirect observation. What the service does well: What has improved since the last inspection? Redecoration and refurbishment of the home continues enhancing the environment for residents. Residents and relatives have been involved in choosing new furniture and colour schemes. Staff recruitment procedures are robust, ensuring that residents’ are protected. The Care Manager has completed a recognised qualification in care thus consolidating her experience and knowledge for the benefit of residents’ The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2.3.4.5 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Systems in place for pre-admission assessments and trial visits are good, ensuring that residents do not move into the home unless their needs can be met. Care plans did not always recognise the strengths of residents with cognitive impairment thus omitting the potential empowerment carers could promote on behalf of residents’. EVIDENCE: One resident’s file sampled did not contain a contract. This was discussed with the management team who stated that the family had taken the contract away to read. The Care manager carries out pre-admission assessments and these meet the standard. Individual details were recorded on this pre-admission assessment. The home accepts residents with dementia. Staff have received training in dementia awareness. The managers and owners have enrolled on a NVQ 2 The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 9 course in dementia care. The managers and owners have consulted with a variety of organizations as to the best practice for residents with cognitive impairment. An example of this the redecoration programme which has incorporated colour schemes that are found to be of positive benefit for residents experiencing cognitive impairment. Care plans however did not demonstrate how residents with dementia would have their specific needs met in relation to this condition. Care planning should not to just focus on difficulties but strengths and abilities and how these can be utilised to the full. Staff have received training in managing aggressive behaviour. Residents are allowed to freely wander around the home, but the bedroom doors can be alarmed so if they are opened this registers on the nurse call and staff are alerted. Trial visits are taking place and recording in relation to the day visits is good. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. There was evidence of good multidisciplinary working taking place on a regular basis but the home was not assessing all health needs and this could potentially lead to poor outcomes for residents. Care planning whilst detailed needs further work to ensure no omissions in care documentation occur. Medication management was mixed with potentially poor outcomes for residents EVIDENCE: Three care plans were looked at during the inspection. These set out the action to be taken by care staff to ensure aspects of health, personal and social care needs are met. There were good examples of individual details in these care plans. Each resident has a daily diary that staff write in every shift and there was good evidence of activities and general events. The diaries did not say what actual physical care or assistance had been given. Relatives spoken to were aware of the daily diary but there was no evidence that residents or their representatives had been involved in drawing up the care plan. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 11 Assessments were in place but findings from these were not being linked back to the care plan, for example the care plan of a resident who was assessed as being at high risk of falls did not state what strategies were in place to reduce this. The staff at the home do two skin integrity assessments, which is duplicating work for themselves. It is recommended that they review this. Residents had a basic mental health assessment in place, which needs to be further developed as the majority of their residents have some cognitive impairment and a more refined tool is needed. Residents did not have a continence management assessment. The home does not have bedrails. There was evidence of multidisciplinary health care involvement in residents’ records. The accident book was not seen at this inspection but will be looked at next visit. One relative commented that residents were “looked after well”. The home employs a physiotherapist who visits once a week for an hour and, residents’ benefit from this service, which is to be commended. Medication was not always auditable. Some of this problem was due to staff not forwarding medication left over and still in stock from the previous month. The original prescriptions were being photocopied and were used to check that the MAR Chart was correct, but these were not being kept together. It is recommended that both be kept together for easy reference. The drug trolley is too small to contain all the medication. So after each medication round the trolley is emptied and all medication is safety secured in a locked cupboard. It is recommended that the home reviews this system either by ensuring the medicine trolley can be secured to a wall and some medication remain in it or ultimately that they purchase a larger trolley. The practice of taking medication in and out of the cupboard is time consuming and could be better spent with residents. The pharmacy inspector for the Commission carried out a visit post inspection and a letter was sent outlining the findings to the home. Residents were observed to be appropriately dressed and their clothes nicely laundered. Staff were observed knocking on residents room doors prior to entering them. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Residents’ independence and choice is maintained through a variety of systems within the home EVIDENCE: There were no rigid rules or routines in evidence at the home. Residents’ preferences and choices were recorded in the care plans. Residents were observed to be able to sit in a variety of communal spaces and wander around the home freely. Visitors are welcomed to the home. Visitors can have a meal at the home. A local church visits the home and during the inspection residents received communion. Residents’ bedrooms were personalized with their own possessions. There were a variety of activities taking place within the home. The garden had recently been altered and residents and visitors were observed sitting outside. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 13 One relative commented that residents “feed well” and “they can always have a drink of what they want, when they want no restricted times”. The inspector had a meal with residents which was nicely presented in a pleasant environment. The cook was not available on the day of the inspection. Residents can choose what they want to eat from a menu. Menus were discussed with the management team as the inspector felt that the tea menu was potentially repetitive. Post inspection, the inspector has been informed by the owner that they have contacted a charitable organization that specializes in helping care homes meet the nutritional needs of residents. The Owner will be reviewing the information they have obtained with the Care Manager but has been initially been impressed by the menus being tailored to residents with cognitive impairment which they feel will be extremely helpful. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Complaints are dealt with in a professional and sensitive manner. Adult protection policy and procedure are followed according to agreed local guidance. EVIDENCE: The home has a comprehensive complaints procedure, which clearly states what to do should anyone wish to make a complaint and provides all the required contact details. The home has had three complaints since the last inspection. Two of these have been from staff concerned about practice within the home. The complaints are dealt with in a professional and sensitive manner. The homes’ management team have made two referrals under adult protection procedures since the last inspection. The homes’ management team have acted appropriately on both occasions. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The Owners continue with their investment programme of improving the appearance of this home and creating a comfortable and safe environment for those living there. EVIDENCE: One relative commented that “they were aware the environment was poor but that was changing”, they went on further to comment that the care being offered to their relative was good and they felt that this was what really mattered. The Owner showed the inspector a five-year refurbishment plan and since the previous inspection one assisted bathroom and communal toilet has been completely refurnished. During the inspection decorators were present, working in one of the corridors adjacent to residents bedrooms. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 16 One relative commented that on visiting the home they were shown two bedrooms. On choosing a room they were consulted on the redecoration and refurbishment. This involved choosing the colour scheme, carpet and moving a radiator so that the resident’s own furniture could be accommodated. There are a variety of communal areas around the home where residents are able to sit quietly or watch television. Residents have been involved in purchasing new furniture for their bedrooms. One resident informed the inspector that they had visited the local furniture shop with the owner and was able to choose an item of furniture not listed on the standard but of great importance to them. This is to be commended. There was a passenger lift and stair lift available in the home. There were other adaptations available in the home including a call system, two mobile hoists, assisted bathing and grab rails in toilets. The Owner informed the inspector post-inspection that a number of new pillows had been ordered for residents. The visit took place on a hot summers day, but the inspector was informed that thermostatic valves had been fitted to all radiators. Radiators were observed to be guarded. The home was clean and there were no malodours noticed around the home. Laundry systems need to be reviewed. Dirty linen was found on the floor of the shower room. Soiled linen is being sluiced by hand and then placed in a bucket to soak before being placed in the washing machine. The option of a red alginate bag system was discussed with the owner and management team. It is recommended that the home contacts the health protection agency who will carry out an environmental audit for them To enter the laundry, staff have to walk though the hairdressing salon. This room is not locked when staff are not working in it. Commode pots are washed in a pot disinfector, which has recently been installed. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Staff undertake regular training ensuring they are able to meet the needs of residents. The home has a robust recruitment procedure in place thus protecting residents. EVIDENCE: Rotas supplied demonstrated that the staffing levels were being maintained at 4 care staff on duty during the day in addition to the manager and deputy manager. In addition to the care staff there were dedicated catering, laundry and cleaning staff. Three staff files were sampled. Staff files in the home contained the relevant documentation in relation to complying with a robust recruitment procedure in accordance with Schedule 2 with the exception that a second reference could not be found on one file. Evidence of this was forwarded after the inspection. A significant number of staff have achieved an NVQ2 in care. Copies of certificates were shown to the inspector. A twelve month schedule of training is drawn up for staff commencing at the beginning of the year. The home also has a training matrix in place to allow for easy tracking of the training undertaken and training required by staff. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 18 An induction programme is in place for new staff that is linked to the Skills for Care programme. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33.35.36.38 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care Manager has recently obtained a recognised qualification in management. Evidence of this had been forwarded to the Commission prior to the inspection. The Care Manager was away on holiday at the time of the inspection so was not present for the inspection. The home’s documentation was well organized and easy to access. The management team and owners work well together as a team. There was a friendly happy relaxed atmosphere in the home. Relatives described the staff as being “kind to the patients’” and being “impressed by the staff’s attitude and caring”. One of the Owners was described as a “very The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 20 gentle pleasant person”. These statements reflect a home that is run in the best interests of the residents. There is a written record of residents’ money with receipts. Money is held individually and securely. Staff supervision is taking place six times a year and meets the standard. The home has various systems in place to monitor quality assurance as well an external organisation carrying out an audit for them once a year. The home obtains the opinions of resident, family and friends via a questionnaire. Health and safety matters on the whole were well managed. Hot water outlets above 43ºC were being identified but it was difficult to ascertain what, if any, action was being taken. Bath and shower hot water outlets should be tested weekly, as there is a higher risk of total immersion in these areas and potential for scalding. The laundry door was being left unlocked when the laundry was not in use. Fridge and freezer temperatures were being recorded and within range. The home needs to revisit the HAZZAP risk analysis as their definition of this was at complete variance with the inspectors. Sacks of potatoes and boxes of cereals in the dry store cupboard need to be lifted off the floor. A number of dry herbs were observed to be out of date and the owner disposed these of during the inspection. The home has the luxury of a large converted attic space this is used for training and storage of incontinence pads. The home needs to review storage of these products as they are heavy and could be conceived as an unnecessary manual handling risk. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 OP4 Regulation 13(1)(c) Requirement The registered person must ensure that service user risk assessments indicate all risks and strategies managing them. (Previous timescale of 01/04/05, 01/11/05 and 01/02/06 not met.) The strategies for managing the risks must be cross-referenced to the care plan. (Previous timescale of 01/02/06 not met) The Registered Person must ensure that the residents or their representative is involved in formulating the care plans. (Previous timescale of 01/02/06 not met) The Registered Person must ensure that residents’ with cognitive impairment have their needs planned for and this includes acknowledgement of residents’ strengths and abilities The Registered Person must ensure that residents have a comprehensive mental health and continence assessment. DS0000062017.V304132.R01.S.doc Timescale for action 30/09/06 2 OP8 12(1) 30/10/06 The Limes Rest Homes Version 5.2 Page 23 3 OP9 13(2) From this a plan of care must be devised to meet recognised needs Staff drug audits must be undertaken on a regular basis to confirm nursing staff competence in medicine management and appropriate action must be taken when discrepancies are found. The Registered Person must ensure that all medication is auditable. The Registered Person must review menus with emphasis on the teatime meals. The Registered Person must review systems in place for dealing with dirty and soiled linen The Registered Person must ensure that the laundry door is locked when no one is present. The Registered Person must ensure that staff do not carry out any unnecessary manual handling tasks. The Registered Person must ensure that food items are not in direct contact with the floor. The Registered Person must provide training for staff in HAZZAP risk analysis. The Registered Person must review monitoring and recording of hot water outlets. 30/09/06 4 5 OP15 OP26 16 (2)(i) 13(4) 30/09/06 30/08/06 6 7 OP38 OP38 13(4) 13(5) 30/09/06 30/09/06 8 9 10 OP38 13(4) 13(4) 13(4) 30/08/06 30/09/06 30/08/06 OP38 OP38 The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP26 OP9 Good Practice Recommendations 1 2 The Registered Person should contact the Health Protection Agency to seek advise on infection control matters The Registered Person should purchase a larger medication trolley. The Registered Person should keep photocopies of the original scripts with the MAR chart so they are easily accessible for cross referencing. The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Limes Rest Homes DS0000062017.V304132.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!